October 14, 2013

HHS Issues 2014-2018 Draft Strategic Plan

The U.S. Department of Health and Human Services (HHS) recently published its draft of the Fiscal Year 2014-2018 Strategic plan. Every 4 years, HHS updates its strategic plan, which describes its work to address complex, multifaceted, and ever-evolving health and human service issues, including:

Health Care

Research and Innovation

Prevention and Wellness

An agency strategic plan is one of three main elements required by the Government Performance and Results Act (GPRA) of 1993 (P.L. 103-62) and the GPRA Modernization Act of 2010 (P.L. 111-352). An agency strategic plan defines its mission, goals, and the means by which it will measure its progress in addressing specific national problems over a four-year period.

HHS is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. HHS is responsible for almost a quarter of all federal expenditures and administers more grant dollars than all other federal agencies combined.

Eleven operating divisions, including eight agencies in the United States Public Health Service and three human service agencies, administer HHS's programs. In addition, staff divisions provide leadership, direction, and policy management guidance to the Department. The 2014-2018 plan has four (4) strategic goals:

Each goal has several objectives and within each objective are strategies. Below is a summary of selected objectives and strategies for each goal.

Goal 1: Strengthen Health Care

HHS is responsible for implementing many of the provisions included in the Affordable Care Act that seek to expand coverage, emphasize prevention, improve the quality of health care and patient outcomes across healthcare settings, promote efficiency and accountability, ensure patient safety, and work toward high-value health care.

Objective A: Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

Make health insurance more affordable by working with states to establish a rate review process that identifies and reviews unreasonable rate increases by health insurance plans, prohibiting discriminatory premium rates based on health status, occupation, or gender, protecting issuers against the financial risk of enrolling a disproportionate number of individuals with significant medical needs, and requiring insurance companies to spend at least 80% of health insurance premiums on medical care, not on profits and overhead;

Collect data to assess the Affordable Care Act's effect on coverage of vulnerable populations, the impact on out-of-pocket expenses on the non-elderly, and how coverage obtained through the Health Insurance Marketplaces may affect access to care for those previously insured, and use these analyses to adjust Affordable Care Act programs to maximize their effectiveness

Objective B: Improve healthcare quality and patient safety

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

Develop new collaborative models of care that incentivize team-based practice and reduce inappropriate care, and use evidence-based medicine to reduce harm and improve outcomes;

Implement payment reforms that reward quality care (e.g., care related to provider-preventable conditions), and work with physicians and other care providers and across the public and private sectors;

Assist professional organizations with developing clinical practice guidelines that address care for individuals with multiple chronic conditions to improve their overall health outcomes and reduce adverse events, including medication errors, while respecting patients' goals for their care;

Educate health care professionals about providing optimal care to and care coordination for individuals with multiple chronic conditions, to improve health status and reduce risks for adverse medical events such as medication error;

Enhance coordination of Medicare and Medicaid to improve quality, cost, and coordination of care, including behavioral health and long-term services and supports, for Medicare-Medicaid enrollees with chronic conditions and functional impairments;

Facilitate public and private collaborations to promote safe medication use by identifying specific, preventable medication risks and developing, implementing, and evaluating cross-sector interventions with partners who are committed to safe medication use;

Improve surveillance, domestically and abroad, of adverse events, errors, or near misses in blood, organ, and tissue procedures, transplant-associated parasitic infections, urgent antimicrobial resistance, drug and medical product safety problems, and other major breaches in infection prevention in healthcare;

Improve surveillance in hospital and non-hospital settings, such as outpatient clinical settings, emergency care, and nursing homes, to identify sources of and control of healthcare-associated infections and other nationally notifiable diseases

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

Support rapid communication and coordination between public health practitioners and clinicians to increase use of evidence-based prevention strategies to address risk factors for disease and health conditions;

Assist state and community efforts to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living;

Promote early entry into primary care, education, and coordinated services for pregnant women and infants;

Explore pathways to support primary prevention activities to control or eliminate health hazards in housing before people, particularly vulnerable populations such as children and older adults, are affected;

Promote effective prevention and treatment of chronic disease by increasing the appropriate use of screening and prevention services, particularly for cancer, heart disease and stroke, chronic lower respiratory disease, and unintentional injury;

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

Design, implement, and evaluate healthcare provider value-based payment programs and initiatives that encourage the delivery of high quality and efficient healthcare services throughout the continuum of care;

Create aligned incentives across Medicaid and Medicare to support healthcare innovation, the development of innovative, person-centered service delivery and payment models that improve quality, increase coordination of care, including long-term services and supports and behavioral health care, and reduce costs;

Develop, test, refine, and expand successful models that incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes for high quality and efficient service delivery, which include promoting enhanced primary care and bundled payments;

Improve accessibility and integration of healthcare databases so researchers can identify cost-saving, health-protective, and quality-enhancing practices;

Increase interoperable health information exchange by healthcare providers across public and private systems;

Support electronic information exchange for notification and reporting among public health and clinical entities;

Engage standards developers, health IT vendors, and other stakeholders to accelerate development, assure availability, and support effective use of consensus standards that meet electronic health information management and exchange needs of consumers and providers throughout the health care system;

Support the design and execution of innovative solutions through the use of challenge and prize competitions. Explore new ways to engage communities and leverage public-private partnerships through innovative use of challenge competitions and authorities granted to us under the America Competes Reauthorization Act of 2010 (P.L.111-358);

Expedite the development of breakthrough therapies intended to treat serious and life-threatening diseases or conditions;

Develop and implement innovative approaches to address the complex global regulatory environment; improve surveillance, monitoring, analysis, and reporting; and help bring to market new drugs, diagnostics, and biologic products;

Use public health data to characterize emerging threats to patient and consumer safety;

Explore ways to integrate health data into mobile health technologies and related social networking platforms to more effectively reach healthcare professionals, patients, families and other members of the public; and

Work closely with HHS agencies and stakeholders to work through the privacy and regulatory issues associated with use of these new technologies in health care and wellness settings.

Develop science-based standards for preventive controls for food and feed safety across the "farm to table" continuum;

Develop an innovative e-learning system to improve the speed, efficiency, and effectiveness of training and best practice dissemination related to food safety efforts in areas such as restaurant inspection and environmental assessments of foodborne illness outbreaks;

Promote the development of new antibacterial drugs to address foodborne pathogens of public health importance;

Develop strategies, such as changes in medication packaging, to prevent medication overdoses in children in collaboration with public and private partners; and

Update medical product review standardsand provide new regulatory pathways for new medical technologies, including those intended for use during public health emergencies;

Support comprehensive and efficient regulatory review, using high standards of transparency and scientific integrity, of new medical treatments and devices and new tobacco products;

Develop new knowledge and tools that can help translate basic scientific discoveries into life-saving medicines, and reduce the time, complexity, and cost of medical product development;

Support regulatory science to facilitate medical countermeasure development and regulatory review; and

Expand regulatory science research to support tobacco product regulation.

Objective D: Increase our understanding of what works in public health and human services practice

Foster early detection and prevention by focusing on preventing bad actors from enrolling or remaining in Medicare and Medicaid before improper payments are made, while ensuring that legitimate providers are able to enroll swiftly and easily;

Require Medicare and Medicaid providers and suppliers to undergo screening, including enhanced screening for certain high-risk providers and suppliers, and take action to exclude those known to commit fraud;

Strengthen oversight of Medicaid expenditures by working with state partners to improve financial accountability for managed care and fee-for-service, provider rate setting, accuracy of state claiming, and beneficiary and provider eligibility processes;

Conduct oversight of Medicare Part C and Part D plan sponsors by conducting audits that detect whether plans are delivering the appropriate healthcare services and medications for which they are being paid;

Improve contractor accountability, coordination and integration across Medicaid and Medicare program integrity initiatives;

Improve Medicare and Medicaid payment accuracy by supporting ongoing initiatives that address the causes of improper payments to ensure that in every case Medicare and Medicaid programs pay the right amount, to the right party, for the right recipient in accordance with the law and agency and state policies;

Identify and proactively address internal and external risks to program performance, monitor programs, contractors, and grantees vigilantly, pursue prosecution and punishment for those who commit fraud, and remedy program vulnerabilities; and

Improve support of, and coordination with, law enforcement by working closely with the Office of the Inspector General, the U.S. Department of Justice and the Federal Bureau of Investigation, to focus on prevention, early detection, and data sharing, moving beyond the paradigm of pay-and-chase, while continuing an aggressive and robust program of criminal investigation and prosecution;